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. 2024 Mar 26;83(12):1149-1159.
doi: 10.1016/j.jacc.2024.01.021.

Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease

Bo Daelman  1 , Liesbet Van Bulck  2 , Koen Luyckx  3 , Adrienne H Kovacs  4 , Alexander Van De Bruaene  5 , Magalie Ladouceur  6 , Hsiao-Ling Yang  7 , Ju Ryoung Moon  8 , André Schmidt  9 , Birgitte Lykkeberg  10 , Edward Callus  11 , Michèle de Hosson  12 , Camilla Sandberg  13 , Bengt Johansson  14 , Joanna Hlebowicz  15 , Maria Emília Areias  16 , Pascal Amedro  17 , Louise Coats  18 , Zacharias Mandalenakis  19 , Anna Kaneva  20 , Philip Moons  21 , Eva Goossens  22 ; APPROACH-IS II consortium; International Society for Adult Congenital Heart Disease
Collaborators, Affiliations
Free article

Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease

Bo Daelman et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.

Objectives: The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.

Methods: Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.

Results: In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.

Conclusions: Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.

Keywords: aging; cognition; congenital heart defects; frailty; frailty phenotype.

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Conflict of interest statement

Funding Support and Author Disclosures This work was funded by KU Leuven–University of Leuven, Research Foundation Flanders through grants 1159522N and 12E9819N; the Swedish Heart and Lung Foundation through grant 20190525; Unidade de Investigação Cardiovascular of Faculdade de Medicina da Universidade do Porto, which supported the costs of the translations into Portuguese used in Portugal; Children’s Heart Unit Fund (CHUF); Newcastle upon Tyne through their funding of the CHUF Fontan nurse specialist; The Taiwan Cardiac Children’s Foundation; Greta and Johan Kock’s foundations; and regional research support southern healthcare region, Skane University Hospital funds. The study was partially supported by Ricerca Corrente funding from the Italian Ministry of Health to Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.